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(EID's) among academicians, scientists, and policy makers in the AsiaPacific
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1. OVERVIEW OF INFECTIOUSDISEASE
INFORMATION FROM PROMED
Below is a biweekly summary of AsiaPacific EID issues based on postings
to the ProMED Electronic Network and other sources. ProMED is the prototype
for a communications system that monitors emerging infectious diseases globally,
an initiative of the Federation of American Scientists (FAS), and cosponsored
by WHO.

ASIA

HONG KONG  NEW FLU STRAIN FROM SOUTH PACIFIC
A new influenza strain from the South Pacific has surfaced in Hong Kong.
To date, 30 people
(aged 1㪿) have contracted the "The New Caledonia Flu", a mutation
strain of H1N1. Symptoms include high fever, cough, and runny nose. Seven
cases (aged 3㪣) were hospitalized for complications (i.e. asthma attack,
seizure, chicken pox).

The vaccine will be available in Hong Kong by September or October of
this year. Vaccination for the Beijing flu, which can provide 55% protection
against this mutation strain, has been advised.
[STRAITS TIMES 1/28/00]

CHINA  POLIOMYELITIS VIRUS DISCOVERED
The Health Ministry has issued a comprehensive antiepidemic action plan
in response to the report of a 16 monthold infant boy with acute poliomyelitis
in one of his limbs. The case was first reported on October 13, 1999.

Isolates from fecal samples of the infant yielded poliomyelitis virus
type 1. A 4year old cousin of the infected child also tested positive
for the wild poliovirus. Neither the case nor any direct contacts reported
a history of travel outside the country during the two months prior to
onset.

TAIWAN  MALARIA IMPORTED
A 23year old from Burma exhibited malaria symptoms after over a 4month
visit to Taiwan. The disease was identified as Plasmodium vivax,
a strain of malaria with an incubation period of 14 days. The strain was
proclaimed extinct in Taiwan by the World Health Organization in 1967.
[ProMED 1/12/00; Taipei Times Online 1/12/00]

MALAYSIA  MALARIA ALERT
A malaria alert has been placed in Penang, after 9 cases, including 2
deaths, were reported in Bukit Gambier last month. The State Health Department
has advised residents to take precautionary measures.

Active case detection and mass blood survey tests on 835 residents, including
265 foreign workers, in the affected areas continue. Quinine, and an improved
drug formula called Artemisinin, will be used for treatment.
[ProMED 1/5/99]

THAILAND  HIV INFECTION
According to the Public Health Ministry, an estimated 1 million people
are HIVinfected in Thailand. Although infection among highrisk groups
continues to decline, the number of HIV positive teenagers is on the rise.
The prevalence of HIV infections among pregnant women and female sex workers
have fallen from 2.9% in 1995 to 1.5%, and from 9.48% in 1994 to 6.5%,
respectively. Infection among intravenous drug users surveyed has increased
steadily from 39% in 1989 to 51%.

Approximately 40,000 people have died of AIDS in Thailand since 1985.
[REUTERS 1/11/00]

JAPAN  HIV CASES MOUNT
In 1999, AIDS and HIV positive cases in Japan reached a record high (780).
The number of AIDS and HIVinfected cases have increased 25% and 16%,
respectively, from 1998.

There is concern that the increase of blood donation applicants HIVpositive
may reflect a growing tendency to use screening as an alternative to regular
HIV testing and counseling.
[NANDOTIMES 1/26/00]

OCEANIA

NEW ZEALAND  CAMPYLOBACTER FOOD POISONING
In the past couple of weeks, over 75 cases of food poisoning have been
reported in Canterbury. Summer barbecues are a common source of Campylobacter,
a debilitating stomach bug. No single source of infection has been identified.
Investigations continue at this time.
[ProMED 1/19/00& 1/18/00]

AMERICAS

FIESTA DIP LINKED TO SHIGELLOSIS
The United States Food and Drug Administration (FDA) has alerted the public
not to purchase or consume 5 layer dips sold under the brand names Senor
Felix's, Trader Joe's, Delicioso, and The Carryout Café, due to potential
contamination with Shigella sonnei bacteria. Fortynine illnesses,
including 5 hospitalizations, have been reported in association with consumption
of the product. The products were voluntarily recalled by the manufacturer,
Senor Felix's Gourmet Mexican Foods Inc. (Baldwin, CA), on January 22.

Symptoms range from bloody diarrhea, cramps, fever, nausea, and vomiting.
The illness can be easily transmitted from person to person; as a result,
individuals with diarrheal disease are advised to take necessary precautions
to prevent its further spread. Infection can be treated with antibiotics.
[FDA PRESS RELEASE 1/27/00; ProMED 1/26/00; WA DOH PRESS RELEASE 1/24/00]

VANCOMYCINRESISTANT STAPH INFECTION
Health officials at the Centers for Disease Control and Prevention (CDC)
have emphasized guidelines to test Vancomycinresistant Staphylococcus;
this followed the fourth report of the infection in the United States.
According to the January 7th issue of Morbidity and Mortality Weekly Report,
many U.S. laboratories are not testing for the antibioticresistant strains
of bacteria appropriately.

PROPOSAL: ELECTRONIC DISEASE SURVEILLANCE SYSTEM
A 50% increase in the fiscal 2001 federal budget has been proposed to
improve the nation's ability to target, contain, and prevent outbreaks
of infectious diseases. The $20 million request will support the development
of a nationwide electronic disease surveillance network and involve privatesector
laboratories in disease surveillance efforts. The network will enable
public health departments to analyze and integrate infectious disease
surveillance information provided by private commercial. Pilot projects
of this type of system have increased disease reporting by as much as
230%.
[REUTERS 1/11/00]

ANIMAL DISEASE RESEARCH
President Clinton has endorsed a $340 million to increase research on
diseases related to bioterrorism and animal diseases. Approximately $40
million of the planned request may be used to fund a more sophisticated
research facility on Plum Island, New York, to study animal diseases that
can easily infect humans; in particular, those that cannot be vaccinated
against. A significant amount may also be used to upgrade the U.S. Agriculture
Department's 30yearold research facility in Ames, Iowa. The extra funds
would be spent over a 7year period.

Evidence concerning the use of germs to attack the U.S. food supply and
growing international trade have contributed to the increased need to
upgrade facilities to protect the $100 billion U.S. livestock industry,
and a safe food supply.
[ProMED 1/19/00]

OTHER

INTERNATIONAL EFFORT TO FIGHT TUBERCULOSIS
Many international governments have adopted the "DOTS" strategy (Directly
Observed Treatment Shortcourse) to fight tuberculosis (TB). To date, more
than 110 nations have signed an agreement to use DOTS to control outbreaks
of the disease in their respective countries.

The strategy uses a multidrug therapy called shortterm chemotherapy,
and a strict health management system to ascertain that patients are observed
taking each dose of antiTB medicine. Patients are required to take 13
pills, of 4 different medications, per day. Those who do not complete
the treatment regimen run a serious risk to develop multidrugresistant
tuberculosis (MDRTB), a more deadly, complicated, and expensive form
of TB to treat.

With DOTS, treatment takes 6פ months, at an average cost of $11 worldwide.
[DESERETNEWS.com 1/16/00]

2. UPDATES FROM PREVIOUS BULLETINS

HUMAN TRANSMISSION OF AVIAN INFLUENZA AResearchers have documented the first epidemiologic evidence that
avian influenza A (H5N1) viruses can be transmitted from persontoperson,
and that asymptomatic H5N1 infections can occur.

A restrospective seroprevalence study in Hong Kong compared the prevalence
of H5N1 antibodies in healthcare workers exposed to patients infected
with the H5N1 strain to the prevalence in healthcare workers not exposed.
Each of the workers were employed at one of three hospitals in Hong Kong
during the 1997 outbreak of H5N1, at which time 18 humans were infected.
Since the illnesses occurred during an outbreak of the virus among domestic
poultry in Hong Kong, workers were also asked to recall any exposure to
poultry during that time.

The results of the study showed that 3.7% of the exposed healthcare workers
and 0.7% of the unexposed workers were positive for H5N1 antibodies, a
finding that "...remained significant after controlling for poultry
exposure".

No cases of H5N1 infection in humans have been reported since 1997.
[J INFECTIOUS DISEASE 2000; 181: 344𤭌]

3. NOTICES

UPDATED RECOMMENDATIONS FOR IMMUNIZATIONS
An updated schedule for childhood immunizations has been approved by the
American Academy of Pediatrics, the Advisory Committee on Immunization
Practices of the Centers for Disease Control and Prevention (CDC) and
the American Academy of Family Physicians.

Modifications from the previous schedule include withdrawal of the recommendation
that children receive the rotavirus vaccine, due to an association with
intussuception; the use of inactivated poliovirus vaccine to eliminate
the risk of vaccineassociated paralytic polio; a combination acellular
pertussis vaccine with diphtheria and tetanus toxoids for pertussis vaccination;
and hepatitis vaccination in certain states or regions.
[REUTERS 1/11/00; PEDIATRICS 2000; 105: 148𤪇]

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